Health inspection·September 6, 2024

§483.12(b) The facility must develop and implement written policies and procedures that: §483.12(c)(1) Ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. § 72523(a) Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. H &S § 1418.91 (a) A long-term health care facility shall report all incidents of alleged abuse or suspected abuse of a resident of the facility to the department immediately, or within 24 hours. (a) A failure to comply with the requirements of this section shall be a class "B" violation. On 7/1/2024 the California Department of Public Health (CDPH) received a complaint alleging a Resident (Resident 1) was smoking a cigarette on the facility's patio when a staff member, Licensed Vocational Nurse 1 (LVN 1), grabbed him by the arm and "tossed him like a paper doll," causing bruising to his arms. On 7/16/2024 at 1:18 p.m., the CDPH conducted an unannounced visit to the facility to investigate the allegation. Upon investigation, the CDPH determined Resident 1 was assessed with bruising to his left arm and right ribcage/flank and made a complaint that LVN 1 assaulted him, and the Director of Nursing (DON) was aware of the allegation of abuse but did not report to the CDPH. The facility failed to: 1. Ensure an allegation of physical abuse was reported to the CDPH when Resident 1 sustained a reddish-purple discoloration to this left arm and right ribcage/flank and made an allegation of abuse. 2. Ensure the facility followed its policy and procedure (P/P), titled, "Reporting Alleged Violations of Abuse, Neglect, Exploitation or Mistreatment," which indicated all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately but not later than two hours after the allegation is made if the events that cause the allegation involves abuse or results in serious bodily injury. Not later than 24 hours if the events that cause the allegation does not involve abuse and does not result in serious bodily injury. As a result, there was a delay in the investigation by the CDPH. A review of Resident 1's Admission Record (Face sheet) indicated Resident 1 was admitted to the facility with diagnosis including chronic obstructive pulmonary disease (a lung disease causing restricted airflow and breathing problems), chronic kidney disease ([CKD] a long term condition where the kidneys do not work well as they should) and anemia (a condition that develops when the blood produces a lower than normal amount of healthy red blood cells). A review of Resident 1's Minimum Data Set ([MDS] a standardized assessment and care screening tool) dated 6/12/2024, indicated Resident 1 was able to make independent decisions that were reasonable and consistent. A review of Resident 1's Skin Evaluation dated 7/3/2024 and timed at 2:11 p.m., indicated Resident 1 had discoloration to his left upper extremity (arm) measuring 1.5 centimeter ([cm] a unit of measurement) and right ribcage/flank measuring 5.0 cm by 6.0 cm. The Skin Evaluation indicated Resident 1 complained of a pain level of 2 out of 10 (an 11 eleven-point scale where pain in rated from zero to 10; 0=no pain, 1-3=mild pain, 4-6=moderate pain, and 7-10=severe pain, and 10=worst imaginable pain), to the right ribcage flank area on palpation. A review of Resident 1's Nursing Progress Notes dated 7/3/2024 and timed at 5:33 p.m., indicated Resident 1 was unaware of how the new discoloration to his left arm and right ribcage area occurred. During a telephone interview on 7/16/2024 at 4:01 p.m., Certified Nursing Assistant 1 (CNA 1) stated on 6/30/2024 Resident 1 was observed with a pair of scissors, and he refused to surrender the scissors to her. CNA 1 stated Resident 1 allowed licensed Vocational Nurse 1 (LVN 1) to search his pockets, and after a few minutes, Resident 1 got mad and tried to push LVN 1 away causing Resident 1's wheelchair to almost fall over, but LVN 1 was able to stop Resident 1's wheelchair from falling. During a telephone interview on 7/16/2024 at 5:10 p.m., LVN 1 stated on 6/30/2024 during the morning shift, he was called to Resident 1's room by nursing staff (name unknown) because Resident 1 had a pair of scissors in his possession and Resident 1 refused to surrender the scissors. LVN 1 stated he asked Resident 1 if he (LVN 1) could search his (Resident 1) pockets. LVN 1 stated Resident 1 allowed him to search his pockets but when he was patting Resident 1's right pocket, Resident 1 became upset, tried to push him away and Resident 1's wheelchair almost fell over, but he (LVN 1) was able to prevent Resident 1 from falling. During a telephone interview on 7/16/2024 at 5:44 p.m., LVN 3 stated on 7/1/2024 during the morning shift, he performed a skin evaluation on Resident 1, who had made an allegation that he was attacked by a nursing staff on 6/30/2024. LVN 3 stated Resident 1 had discoloration on his right hand and right arm. LVN 3 stated on 7/3/2024 during the morning shift, he observed Resident 1 had new reddish purplish discolorations on his left arm. LVN 3 stated he observed a reddish purplish discoloration on Resident 1's right ribcage/flank area as well, which was painful to touch. LVN 3 stated Resident 1 told him it might be from the incident on 6/30/2024. LVN 3 and he immediately reported his observation to the DON. During an interview on 7/17/2024 at 2:10 p.m., the DON stated Resident 1's skin discoloration on his left arm and right ribcage area was new and Resident 1 did not know where the discoloration came from. The DON stated she did an investigation and found that Resident 1 had been on a long term anticoagulant (a medication that prevents or treats blood clots, also called a blood thinner) in the past and steroid therapy (medications used to reduce inflammation and ease swelling, pain, and stiffness) which could have caused Resident 1 to bruise easily. The DON stated that was why she did not report Resident 1's injury to CDPH. A review of the facility's P/P, titled, "Reporting Alleged Violations of Abuse, Neglect, Exploitation or Mistreatment, revised 12/2023, indicated in response to allegations of abuse, neglect, exploitation, or mistreatment, the facility will: ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately but not later than two hours after the allegation is made if the events that cause the allegation involves abuse or results in serious bodily injury. Not later than 24 hours if the events that cause the allegation does not involve abuse and does not result in serious bodily injury. A review of the facility's P/P, titled, "Reporting Alleged Violations of Abuse, Neglect, Exploitation or Mistreatment," revised 12/2023, indicated an alleged violation such as a situation including injuries of unknown source must be reported to the appropriate agencies as designated by State and Federal Laws. The facility failed to: 1. Ensure an allegation of physical abuse was reported to the CDPH when Resident 1 sustained a reddish-purple discoloration to this left arm and right ribcage/flank and made an allegation of abuse. 2. Ensure the facility followed its policy and procedure (P/P), titled, "Reporting Alleged Violations of Abuse, Neglect, Exploitation or Mistreatment," which indicated all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately but not later than two hours after the allegation is made if the events that cause the allegation involves abuse or results in serious bodily injury. Not later than 24 hours if the events that cause the allegation does not involve abuse and does not result in serious bodily injury. As a result, there was a delay in the investigation by the CDPH. These violations, jointly, separately or in any combination, had direct or immediate relationship to the health, safety, or security and welfare of Resident 1.